Clinical

1. SYNDROMES OF
SPINAL CORD
lesions
Prof. Nabil Khalil
Suez canal university

2. • It is divided into complete and incomplete
cord syndromes.
• INCOMPLETE CORD SYNDROMES.
• Brown sequards syndrome.
• Central cord syndrome.
• Anterior cord syndrome.
• Posterior cord syndrome.
• Conus medullaris syndrome.
• Cauda equina syndrome.

3. COMPLETE CORD
TRANSECTION

4. Complete transaction of spinal
cord
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causesTrauma
Metastatic carcinoma
Multiple sclerosis
Spinal epidural haematoma
Autoimmune disorders
Post vaccinial syndromes.
All ascending tracts from below and
descending tracts from above are interrupted.
• Affects motor sensory and autonomic
functions.

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SENSORY
all sensations are affected.
Pin prick test is very valuable.
Sensory level is usually 2 segments below the
level of lesion.
Segmental paresthesia occur at the level of
lesion.
Motor-paraplegia due to corticospinal tract.
First spinal shock-followed by hypertonic
hyperreflexicparaplegia.
Loss of abdominal and cremastric reflexes.
At the level of lesion LMN signs occur.
AutonomicUrinary retention and constipation.
Anhidrosis ,trophic skin changes, vasomotor
instability below the level of lesion.
Sexual dysfunction can occur.

6. BROWN SEQUARDS SYNDROME

8. BROWN SEQUARDS
SYNDROME
• Due to damage to one lateral half of spinal
cord.
• SENSORY
• Ipsilateral loss of proprioception due to post
column involvement.
• Contralateral loss of pain and temperature due
to .involvement of lateral spinothalamic tract.
• MOTOR-Ipsilateral spastic weakness due to
descending corticospinal tract involvement
• LMNsigns at the level of lesion.
• Caused by extramedullary lesions
• Usually caused by penetrating trauma or
tumour.

9. CENTRAL CORD SYNDROME

10. CENTRAL CORD SYNDROME

12. CENTRAL CORD SYNDROME
• Most common cause is syringomyelia.others
hyperextension injuries of neck,intramedullary
tumours,trauma.
• Associated with chiari type 1 and 2.and dandy
walker malformation.
• SENSORY
• Pain and temperature are affected.
• Touch and proprioception are preserved.
• Dissociative anaesthesia.
• Shawl like distribution of sensory loss.
• MOTOR.
• Upper limb weakness >lowerlimb

13. • Other features;
– Horners syndrome
– Kyphoscoliosis
– . Sacral sparing
– Neuropathic arthropathy of shoulder and elbow
joint
– Prognosis is fair.

14. POSTERIOR COLUMN
SYNDROME
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Occurs due to neurosyphilis,diabetes mellitus
Usually occurs 10 to 20 yrs after infection
SENSORY
Impaired position and vibration sense in LL
Tactile and postural hallucinations can occur.
Numbness or paresthesia are frequent
complaints..
Sensory ataxia.
Positive rhomberg sign.
Positive sink sign
Positive lhermittes sign.

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Abadie’s sign positive.
Urinary incontinence.
Absent knee and ankle jerk.(areflexia,hypotonia)
Abdominal and laryngeal crisis can occur.
Charcots joint.
miotic and irregular pupil not reacting to light.
Argyl robertson pupil

16. POSTERO LATERAL COLUMN
DISEASE
– CAUSES;
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VITB12 DEFICIENCY
AIDS
HTLV ASSOCIATED MYELOPATHY.
CERVICAL SPONDYLOSIS
Paresthesia in feet
Loss of proprioception and vibration in legs
Sensory ataxia

17. • positive rhomberg sign
• Bladder atony
• Corticospinal tract
involvement;spasticity,hyperreflexia
,bilateral Babinski sign.
• Aids:associated dementia and spastic
bladder is present
• HTLV associated myelopathy;slowly
progressive paraparesis increase in csf igG
with antibodies to HTLV1.

18. ANTERIOR HORN CELL
SYNDROMES
• CAUSED BY SPINAL MUSCULAR
ATROPHY.
• MOTOR
• weakness ,atrophy and fasciculations.
• Hypotonia,depressed reflexes.
• Muscles of trunk and extremities are
affected.
• Sensory system is not affected.

19. Ant horn cell and pyramidal tract
syndrome
• Occurs in amytrophic lateral sclerosis.
• Affects the ant horn cells and corticospinal
tract.
• Both lmn and umn sign occur.
• MOTOR
• Ant horn cell-paresis ,atrophy,and
fasciculations.
• Corticospinal tract –paresis ,spasticity and
extensor plantar response.
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20. • its usually unilateral with muscle
weakness
• Reflexes are often exaggerated.
• Bulbar and pseudo bulbar involvement
occurs.
• Sensory system is not affected.
• Superficial reflex-abdominal reflex is
preserved

21. SPINAL ARTERY

22. ANTERIOR SPINAL ARTERY
SYNDROME.

23. VASCULAR SYNDROMES OF
SPINAL CORD
• Mostly occurs due to anterior spinal artery.
• conus medullaris is frequently involved.lies
opposite to vertebral bodies T12 and L1.
• Neck pain of sudden onset.
• MOTOR
• Flaccid and areflexic paraplegia

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SENSORY
Loss of pain and temperature.
Preservation of positon and vibration.
AUTONOMIC
urinary incontinence.
Spinal cord infarction usually occurs in
T1 to T4 segment.and L1
• Occurs due to syphilitic arteritis ,aortic
dissection,atherosclerosis of
aorta,SLE ,AIDS,AV malformation

25. • POST SPINAL ARTERY SYNDROME
• UNCOMMON
• Loss of proprioception and vibratory
sense.
• Pain and temperature is preserved.
• Absence of motor deficit.

26. CONUS MEDULLARIS
SYNDROME
• Contributes to 25%spinal cord injuries.
• Lies opposite to vertebral bodies of T12
and L1.
• Caused by flexion distraction injuries and
burst fractures.
• Both UMN and LMN deficits occur.
• Development of neurogenic bladder.

27. CAUDA EQUINA SYNDROME

28. CAUDA EQUINA SYNDROME.
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Begins at L2 disk space distal to conus
medullaris.
MOTOR
Flaccid lower extremities.
Knee and ankle jerk absent.
SENSORY-Asymmetrical sensory loss
Saddle anaesthesia
Loss of sensation around
perineum,anus,genitals.
AUTONOMIC-Loss of bladder and bowel
function.
Urinary retention.
Occurs due to acute disk herniation epidural
haematoma,tumour

29. ANTERIOR CORD
SYNDROME

30. ANTERIOR CORD
SYNDROME

31. ANTERIOR CORD
SYNDROME
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Usually caused by hyperflexion injuries.
Paralysis below the level of lesion.
Pain and temperature loss.
Dorsal column is preserved.
Prognosis is poor.
Area supplied by anterior spinal artery is
affected.

32. •THANK YOU